Telepsychology: Use of Skype and Other Telecommunications by Psychologists

Psychology services delivered through video conferencing? They’re becoming common — and can be quite attractive to patients as well as therapists. Some patients live in such small communities that they fear that they (or individuals they talk about) may already be known to their therapist. Some live in remote areas where there isn’t much choice of therapists and where some services may not be available at all. Some clients are homebound, careless, or just lead hectic, busy lives.

Chances are telepsychology isn’t going away! Still it creates unique challenges that a psychologist needs to think through. That’s why the American Psychological Association, the Association of State and Provincial Psychology Boards (ASPPB) and the APA Insurance Trust (APAIT) spent two years working on a set of guidelines (https://www.apa.org/practice/guidelines/telepsychology).

Interjurisdictional Issues

If a psychologist is providing therapy to a client who is in another state, they are providing services in that state, even if they are physically residing someplace else. That means they need to be licensed, or otherwise legally authorized, to practice in that other jurisdiction. The licensing process can be expensive and cumbersome. Many jurisdictions have some provision for temporary practice. However, they have varying policies about what constitutes a legitimate reason for applying for one. Even a temporary practice permit will generally carry some cost and entail a little work.

A psychologist who is practicing in another state needs to follow the statutes and rules of that jurisdiction, including, but not limited to, policies for telepsychology. Some states have issued their own guidelines for telepractice.

The APA has published a list of pertinent information from each state, including information about temporary practice, and also statements specifically about telepsychology.The APA cautions,however, that the document is not updated on a routine basis and that psychologists who depend on it should go straight to the source (https://www.apa.org/practice/guidelines/telepsychology).

The Association of State and Provincial Psychology Boards provides links to all state licensing agencies.

Confidentiality and Ethical, Informed Practice

Telecommunication can also make issues of confidentiality more complex. Is Skype HIPAA-compliant? This has been the subject of debate. Some believe that the potential for confidentiality breaches is lower than it is with the telephone, mail – or even the practitioner’s file cabinet. However, before commencing practice, you should get the current information from someone in the know.

Technologies can make it trickier to follow ethical and scientific standards; sometimes they can make it harder to follow therapist intuition.

A person still needs to obtain informed consent – and to document it. The Joint Force has recommended that issues involving (or potentially involving the technology be included in the statement.

Some assessments are difficult to administer online. The New York Times notes, in an online article, some of the ways therapy can be altered by not having access to the same information one might in the real world.

Insurance Issues

Malpractice insurance is an important part of safe practice. It’s important to know if the particular services being rendered are covered.

American Professional Agency and the American Psychological Association Insurance Trust (APAIT), two carriers that psychologists commonly turn to, both report to Zur Institute that telepsychology would be covered under certain circumstances. However, psychologists could lose out if they were practicing outside the law (https://www.zurinstitute.com/).

Some jurisdictions actually require that telepsychology services be covered at least under certain conditions (for example, if the patient lives in a rural area. A good starting place is the APA chart of state-specific information (https://www.apa.org/practice/guidelines/telepsychology).

Resources

Psychologists may also wish to take continuing education courses that specifically address the use of Skype and other telecommunications. The following resource is from the Zur Institute’s course on telemental health. Zur is an APA-approved continuing education provide — you can sign up to get the full course.

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